In 2006, the Medicare Part D program was introduced to help seniors and people with disabilities pay for their prescriptions. While the mission of the program is positive, in practice the bureaucratic red tape has left many pharmacists frustrated.
For the past few years, reimbursements for prescriptions covered by Medicare Part D have dropped precipitously, making it difficult for independent pharmacists to maintain a profit. With all the hassle, is it really worth it for pharmacists to court patients enrolled in Medicare Part D?
In short, yes.
In 2018, 37 percent of all prescriptions dispensed by community pharmacies were covered by Medicare Part D according to the 2019 NCPA Digest. Since the program was introduced, enrollment in the program has nearly doubled from 22 million to 44.9 million in 2019, and that number will only continue to grow as the U.S. population ages.
With such a large pool of patients enrolled in Medicare Part D, pharmacists can’t afford to ignore them. According to the Kaiser Family Foundation, 22 percent of Medicare beneficiaries have five or more chronic health conditions on average, and they spend an average of $651 out-of-pocket on prescription drugs throughout the year.
Luckily, there are ways to turn Medicare into a strength for your pharmacy. By catering to the specific needs of Medicare Part D patients, you can turn them into some of your most loyal customers.
Be ready for open enrollment
Medicare enrollment takes place every year from October 15 and December 7. If you play your cards right, you can turn that enrollment period into a boon for your pharmacy.
Patients aren’t experts in healthcare plans. As a pharmacist, you can educate them about their Medicare options and ensure their needs are met, all while reminding them about the unique services and excellent customer service your independent pharmacy provides.
Host enrollment consultations
By offering Medicare enrollment consultations, you can capture the attention (and gain new business) from Medicare beneficiaries. These consultations are one-on-one meetings where you help them sort through all their options. Encourage patients to schedule appointments, but also reserve time for walk-in consultations.
Promote these consultations through your regular marketing channels, then do a bigger media push. Reach out to TV stations or newspapers and offer to share expertise, and if you get asked to do an interview, emphasize how patients can get more help by coming into the pharmacy. Start your marketing efforts before enrollment starts in October, and then do a second push as the enrollment period nears its close. Many patients wait until the last week or two to enroll, and they’ll appreciate assistance in their frenzy to finish their application.
New enrollees are particularly good candidates for enrollment consultations since they are Medicare novices. Set up an alert in your computer system for newly-eligible patients and extend an invitation to come in for a consultation.
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Offer valuable resources and expertise
Patients enrolling in Medicare may not even know what questions they should ask in order to get the coverage they need. That’s why you’re expertise as a healthcare professional is so valuable.
Ask them about their health, the medications they take, and any conditions they have to make sure their Medicare plan will have them fully covered. And be prepared to answer the most commonly asked questions about Medicare.
Embrace technology to make comparing plans simple. Medicare’s Plan Finder is the Center for Medicare and Medicaid Services’ online tool for comparison shopping. Another option is Amplicare Match (formerly iMedicare), which syncs with pharmacy computer systems and allows pharmacists to generate plan comparisons for individual patients. It works all year round — not just during the 53-day enrollment period.
Understanding medicare advantage
Medicare is divided up into several parts — Part A and Part B provide inpatient and outpatient care, and are also known as “Original Medicare.” Most people receive these benefits directly from the federal government. Part D covers prescription drugs, and it’s only available through private insurance companies. That is what patients are signing up for during open enrollment.
Medicare Advantage, sometimes known as Medicare Part C, bundles everything into one plan, and it’s offered by private insurance companies during the same open enrollment period as Part D. These plans can contain benefits that aren’t covered by Original Medicare, like vision, hearing, dental, and wellness programs, and patients can create customized coverage for their specific needs.
However, while Original Medicare covers visits to most doctors and hospitals, Medicare Advantage plans often come with network restrictions and a more limited choice of providers.
Some of your patients might enroll in a Medicare Advantage plan, only to realize it doesn’t cover the providers they have existing relationships with. If they decide their plan isn’t right for them, there’s a Medicare Advantage Disenrollment Period from January 1 through February 15. Patients who leave their Medicare Advantage plan will then be enrolled in Original Medicare.
If you helped patients enroll in a Medicare Advantage plan in the fall, check in with them in January to see if they are happy with their plan. If they aren’t, let them know about the disenrollment option.
Not Preferred? Don’t Panic
Medicare Part D encourages patients to use pharmacies within a preferred pharmacy network. If you’re not in that exclusive club, don’t worry — it doesn’t have to mean the end of that patient relationship.
Compare costs
When a patient comes into the pharmacy and says they need to switch to a preferred pharmacy, be armed with the facts.
Let them know that you value them as a patient and you want to find ways to continue to serve them. Before they leave the pharmacy for good, take the time to sit with the patient and go over their options.
Many people will hear that they need to use a preferred pharmacy and rush to make the switch without fully realizing the implications. By performing an analysis with them, you can help them understand what they are saving by switching — and the benefits they’re leaving behind.
An analysis will often show that the difference between drug costs is minimal, if not the same. And by leaving the community pharmacy, patients are often leaving behind personalized care and service that’s well worth the difference in drug costs.
Pharmacists can use Amplicare Match to compare costs for patients or visit Medicare’s Plan Finder.
Maintain the relationship
You may not be able to convince your patient to stay with you instead of the preferred pharmacy, and while that’s not the ideal outcome, there are still things you can do to salvage the relationship.
Let patients know that even if they aren’t filling their prescriptions with you, you still hope to see them in the pharmacy. Remind them of all the other services you provide, like immunizations, diabetes care, compounding, and more, and point out any unique over-the-counter products you stock.
By remaining friendly and open despite the loss of business, you’ll leave patients with a good impression and they’ll be more likely to stop by when they need front-end products or pharmacy services.
An Independently Owned Organization Serving Independent Pharmacies
PBA Health is dedicated to helping independent pharmacies reach their full potential on the buy side of their business. The company is a member-owned organization that serves independent pharmacies with group purchasing services, expert contract negotiations, proprietary purchasing tools, distribution services, and more.
PBA Health, an HDA member, operates its own NABP-accredited (formerly VAWD) warehouse with more than 6,000 SKUs, including brands, generics, narcotics CII-CV, cold-storage products, and over-the-counter (OTC) products.
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